Medical

The City of San José Currently Offers a Choice of Nine Medical Insurance Plans

Anthem $20 Copay Traditional HMO
Anthem $20 Copay Select HMO
Anthem $1,500 Deductible Select HMO
Anthem $100 Deductible Select PPO
Anthem $100 Deductible Classic PPO
Anthem $2,500 Deductible Classic PPO - HSA Qualified
Kaiser Permanente $25 Co-Pay HMO
Kaiser Permanente $1,500 Deductible HMO
Kaiser Permanente HSA Qualified $3000 Deductible HMO

See the 2024 Medical Plan Comparison for a side by side comparison of our available plans.

A Health In-Lieu plan is available for employees with alternate group medical coverage. For more information, see the details in the Plan Information area below and/or the Health In Lieu Plan Document (2024).

Cost

Employee and City contribution amounts are subject to change each year in January in accordance with contract renewals. Employee contributions toward monthly premiums are determined by the applicable Memorandum of Agreement (MOA) for each bargaining unit or the Benefit and Compensation Summary. See rate sheets below.

2024 Medical Plan Rates - For employees represented by POA or IAFF
2024 Medical Plan Rates - For all other employees
2025 Medical Plan Rates - For employees represented by POA or IAFF
2025 Medical Plan Rates - For all other employees

PLAN INFORMATION

Anthem Plan Information

Group: 282397

Website: https://www.anthem.com/ca/csj/

Anthem Micro-site Find a Doctor User Guide

Anthem Representative: Tanya Astar; (408) 966-0405, Tanya.Astar@anthem.com

Anthem Phone:

(844) 963-0448 (PPO Plans)
(833) 913-2245 (HMO Plans)

(844) 860-3535 (HSA Compatible Plan)

Newly enrolled Anthem members, or members who have switched between Anthem plans will receive a new member ID card for 2024.

Anthem HIPAA Privacy Policy

Anthem Infertility Rider (HMO Plans)

Pharmacy Summary of Benefits for HMO Plans

Pharmacy Directory CA

2024 Plan Year Documents (effective 1/1/2024)

$20 Copay Traditional HMO

$20 Copay Select HMO

$1,500 Deductible Select HMO

$100 Deductible Select PPO

$100 Deductible Classic PPO

$2,500 Deductible Classic PPO (HSA Eligible)

Pharmacy Benefit of Benefits for PPO Plans

Pharmacy Directory CA

Anthem Resources

Kaiser Resources and Plan Information

Website: http://my.kp.org/cityofsanjose

Phone: (800) 464-4000

2024 Plan Year Documents - (effective 1/1/2024)

$25 Copay HMO Group #887

$1,500 Deductible HMO

$3,000 Deductible (HSA Eligible)

Kaiser Brainsharks (3-5 minute overview videos)

Kaiser Resources

As of January 1, 2015, Kaiser Permanente began to automatically track medical and pharmacy services to the annual Out-of-Pocket maximum for members. The Affordable Care Act (ACA) requires the accumulation of all services that are subject to cost sharing for both HMO and Deductible HMO plans and, as a result of this new reporting requirement, Kaiser members may start to receive a Letter of Accumulation (LOA). Instructions on how to understand the statement are provided below, along with a sample view of the format of the letter.

Health In-Lieu

The Health In-Lieu plan allows eligible employees who are covered for health insurance through another group health plan a choice between selecting or continuing nontaxable health coverage under one of the City’s health insurance plans, or declining/dropping the City’s coverage and receiving a taxable in-lieu cash payment. The City’s Health In-Lieu plan does not qualify as a group health plan for COBRA purposes.

Payment/Taxes

Payment will be made to the employee on their regular biweekly payroll check. Payment is taxable, and subject to tax withholdings. The Plan Year on which the Plan operates (including elections and payments) is the calendar year. Payment will not be made for failure to provide acceptable proof of alternate group coverage.

Eligibility

Full-time and Reduced Work Week (35+ hours per week) employees, who certify that they have alternate group coverage, and provide proof of alternate group coverage which is acceptable to the City of San José, are eligible for the Plan. Eligible employees who receive healthcare coverage as a dependent of another City employee or retiree are only eligible for the Single In-Lieu plan. Employees on an unpaid leave of absence are not eligible for the Plan and in-lieu payments.

Enrollment/Elections

Eligible employees may enroll online through eWay upon new hire, during the annual open enrollment period (typically held the first two weeks of November), or within 30 days of a qualifying life event.

The Plan and in-lieu payments are effective on the first day of the following calendar year. Employees may apply for Health In- Lieu or switch from Health In- Lieu to a medical plan during the year only if they become eligible due to a qualifying life event/change in family status and must apply within 30 days of the date of that change.

Health In-Lieu Attestation Verification

The IRS requires proof of alternate group coverage to be submitted to the City every year that the health/dental In-Lieu plan applies. The federal regulation states proof of alternate group coverage may include the employee’s attestation that the employee and all other members of the employee’s expected tax family have or will have minimum essential coverage. Annually, following Open Enrollment, employees enrolled in Health and/or Dental In-Lieu will need to complete the Health and/or Dental In-Lieu Attestation in order to qualify for the health/dental in-lieu premiums for the calendar year. Employees enrolled in the In-Lieu programs will receive an automatic email from HR Benefits requesting the completion of the Attestation. Employees will continue to receive these emails until the Attestation has been completed and will have 30 days to complete. If the Attestation is not completed by the deadline enrollment in the In-Lieu plan(s) will be canceled and medical/dental coverage will be waived.

Important Dates 2024:

Monday, January 22nd: Currently enrolled in Health and/or Dental In-Lieu will need to complete the 2024 Health and/or Dental In-Lieu Attestation.
Friday, February 16th: The deadline to complete the Attestation
March 1, 2024: Employees who fail to complete will have medical coverage waived effective 3/1/24.

Review the 2024 HIL/DIL eForm Attestation Instructions to learn about how to complete the eForm.

Need more information?

For more information, see the details in the Health In Lieu Plan Document.

Eligibility

All full-time and part-time benefited employees may enroll themselves and their eligible dependents in one of the City’s medical plans.

Contact Us

For information about the City's medical plans, email Human Resources - Employee Benefits at HRBenefits@sanjoseca.gov.

For information regarding the City’s cost sharing arrangement for premiums, contact the Office of Employee Relations at (408) 535-8150.

City of San José HIPAA Privacy Statement

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